<table cellpadding="4" cellspacing="0" class="wdform_table1" style="border-top:0px solid black;"><tbody id="form_id_tempform_view1" class="wdform_tbody1" page_title="Untitled page" next_title="Next" next_type="button" next_class="wdform_page_button" next_checkable="false" previous_title="Previous" previous_type="button" previous_class="wdform_page_button" previous_checkable="false"><tr class="wdform_tr1"><td class="wdform_td1"><table class="wdform_table2"><tbody class="wdform_tbody2"><tr id="17" type="type_editor"><td id="17_element_sectionform_id_temp" align="left" valign="top" colspan="2" class="toolbar_padding"><h3>Interested in Respiratory Therapy at SJVC Visalia?<br>Please fill out and submit the form below.</h3></td></tr><tr id="1" type="type_text"><td valign="middle" align="left" id="1_label_sectionform_id_temp" class=""><span id="1_element_labelform_id_temp" class="label">Full Name (First and Last)</span><span id="1_required_elementform_id_temp" class="required"></span></td><td valign="middle" align="left" id="1_element_sectionform_id_temp" class=" toolbar_padding"><input type="hidden" value="type_text" name="1_typeform_id_temp" id="1_typeform_id_temp"><input type="hidden" value="no" name="1_requiredform_id_temp" id="1_requiredform_id_temp"><input type="hidden" value="no" name="1_uniqueform_id_temp" id="1_uniqueform_id_temp"><input type="text" style="width: 200px;" class="input_deactive" id="1_elementform_id_temp" name="1_elementform_id_temp" value="" title="" onfocus="delete_value(&quot;1_elementform_id_temp&quot;)" onblur="return_value(&quot;1_elementform_id_temp&quot;)" onchange="change_value(&quot;1_elementform_id_temp&quot;)"></td></tr><tr id="5" type="type_submitter_mail"><td valign="middle" align="left" id="5_label_sectionform_id_temp" class=""><span id="5_element_labelform_id_temp" class="label">E-mail:</span><span id="5_required_elementform_id_temp" class="required"></span></td><td valign="middle" align="left" id="5_element_sectionform_id_temp" class=" toolbar_padding"><input type="hidden" value="type_submitter_mail" name="5_typeform_id_temp" id="5_typeform_id_temp"><input type="hidden" value="no" name="5_requiredform_id_temp" id="5_requiredform_id_temp"><input type="hidden" value="no" name="5_sendform_id_temp" id="5_sendform_id_temp"><input type="hidden" value="" name="5_uniqueform_id_temp" id="5_uniqueform_id_temp"><input type="text" style="width: 200px;" class="input_deactive" id="5_elementform_id_temp" name="5_elementform_id_temp" value="" title="" onfocus="delete_value('5_elementform_id_temp')" onblur="return_value('5_elementform_id_temp')" onchange="change_value('5_elementform_id_temp')"></td></tr><tr id="3" type="type_number"><td valign="middle" align="left" id="3_label_sectionform_id_temp" class=""><span id="3_element_labelform_id_temp" class="label">Phone:</span><span id="3_required_elementform_id_temp" class="required"></span></td><td valign="middle" align="left" id="3_element_sectionform_id_temp" class=" toolbar_padding"><input type="hidden" value="type_number" name="3_typeform_id_temp" id="3_typeform_id_temp"><input type="hidden" value="no" name="3_requiredform_id_temp" id="3_requiredform_id_temp"><input type="hidden" value="no" name="3_uniqueform_id_temp" id="3_uniqueform_id_temp"><input type="text" style="width: 200px;" class="input_deactive" id="3_elementform_id_temp" name="3_elementform_id_temp" value="" title="" onkeypress="return check_isnum(event)" onfocus="delete_value(&quot;3_elementform_id_temp&quot;)" onblur="return_value(&quot;3_elementform_id_temp&quot;)" onchange="change_value(&quot;3_elementform_id_temp&quot;)"></td></tr><tr id="4" type="type_checkbox"><td valign="top" align="left" id="4_label_sectionform_id_temp" class=""><span id="4_element_labelform_id_temp" class="label">Receive text messages from SJVC:</span><span id="4_required_elementform_id_temp" class="required"></span></td><td valign="top" align="left" id="4_element_sectionform_id_temp" class=" toolbar_padding"><input type="hidden" value="type_checkbox" name="4_typeform_id_temp" id="4_typeform_id_temp"><input type="hidden" value="no" name="4_requiredform_id_temp" id="4_requiredform_id_temp"><input type="hidden" value="no" name="4_randomizeform_id_temp" id="4_randomizeform_id_temp"><input type="hidden" value="0" name="4_allow_otherform_id_temp" id="4_allow_otherform_id_temp"><input type="hidden" value="0" name="4_allow_other_numform_id_temp" id="4_allow_other_numform_id_temp"><table><tbody id="4_table_little"><tr id="4_element_tr0"><td valign="top" id="4_td_little0" idi="0"><input type="checkbox" id="4_elementform_id_temp0" name="4_elementform_id_temp0" value="Yes" onclick="set_checked('4','0','form_id_temp')"><label id="4_label_element0" class="ch_rad_label" for="4_elementform_id_temp0">Yes</label></td></tr></tbody></table></td></tr><tr id="8" type="type_submit_reset"><td colspan="2" class="toolbar_padding" id="8_label_and_element_sectionform_id_temp"><table id="8_elemet_tableform_id_temp"><tbody><tr><td valign="middle" align="left" id="8_label_sectionform_id_temp" style="display: none;" class=""><span id="8_element_labelform_id_temp" style="display: none;">type_submit_reset_8</span></td><td valign="middle" align="left" id="8_element_sectionform_id_temp" class=""><input type="hidden" value="type_submit_reset" name="8_typeform_id_temp" id="8_typeform_id_temp"><button type="button" class="button_submit" id="8_element_submitform_id_temp" value="Submit" onclick="check_required('submit', 'form_id_temp');">Submit</button><button type="button" class="button_reset" style="display: none;" id="8_element_resetform_id_temp" value="Reset" onclick="check_required('reset');">Reset</button></td></tr></tbody></table></td></tr><tr id="6" type="type_editor"><td id="6_element_sectionform_id_temp" align="left" valign="top" colspan="2" class="toolbar_padding"><p>By submitting this form, you acknowledge that SJVC will contact you by phone, email, mail or text message (if you opted in). You are giving SJVC express consent to contact you at the phone number provided for responding to this inquiry, and this will include removal of the number from SJVC's Do Not Call List. View our <a data-mce-href="http://www.sjvc.edu/privacy-policy" href="http://www.sjvc.edu/privacy-policy" title="Privacy Policy" target="_blank">privacy policy</a> for details on how your information may be used.</p></td></tr></tbody></table></td></tr><tr class="wdform_footer"><td colspan="100" valign="top"><table width="100%" style="padding-right:170px"><tbody><tr id="form_id_temppage_nav1"></tr></tbody></table></td></tr></tbody></table>